| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,028 |
2,650 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,693 |
1,279 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
6,882 |
6,682 |
$140K |
| D1120 |
Prophylaxis - child |
4,819 |
4,669 |
$116K |
| D1110 |
Prophylaxis - adult |
2,729 |
2,641 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,588 |
953 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,572 |
3,430 |
$72K |
| D0145 |
Oral evaluation for a patient under three years of age |
761 |
723 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,337 |
7,078 |
$66K |
| D1206 |
Topical application of fluoride varnish |
6,795 |
6,568 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
7,574 |
7,281 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,741 |
2,664 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
402 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
782 |
752 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
597 |
589 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
192 |
185 |
$3K |
| D0330 |
Panoramic radiographic image |
210 |
191 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
25 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$921.44 |
| D9310 |
|
143 |
140 |
$837.23 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$229.44 |
| D0160 |
|
12 |
12 |
$104.69 |
| D1330 |
|
490 |
468 |
$79.57 |
| D0601 |
|
4,107 |
3,946 |
$13.90 |
| D0603 |
|
2,765 |
2,649 |
$0.71 |
| D0602 |
|
1,979 |
1,925 |
$0.51 |